Critical Illness Polyneuropathy and Myopathy

As many as 70% of patients with SIRS, sepsis, or MOF have either a polyneuropathy or myopathy [Musc Nerve 32: 140, 2005], but usually these disorders are overshadowed by more obvious conditions. [NEJM 348: 745, 2003]

Polyneuropathy is treated by prevention and tight glucose control – one study showed that glucose control can reduce the incidence by 44% [NEJM 345: 1359, 2001]. 50% of patients will recover completely, but can take months.

Myopathy presents as diffuse weakness, depressed DTRs, and mildly elevated CK levels [Curr Rheum Rep 4: 403, 2002]. It is more prevalent with longer term use of corticosteroids and neuromuscular blocking agent [Musc Nerve 32: 140, 2005, Curr Rheum Rep 4: 403, 2002]. There is no specific treatment, and recovery may take months. Beware respiratory insufficiency (cough, clearing secretions, and ventilation) – if PImax < 30 cm H20, the patient has severe respiratory muscle weakness and should be intubated. [Am Rev Res Dis 138: 867, 1988]

When critical illness-associated myopathy is a concern and paralysis is needed, cisatracurium may be the drug of choice – in a recent randomized controlled trial designed to study the use of paralysis in patients with ARDS, the use of cisatracurium was not associated with an increased risk of muscle weakness [Papazian L et al. N Engl J Med 363: 1107, 2010].



Charles F Bolton
Neuromuscular manifestations of critical illness.
Muscle Nerve: 2005, 32(2);140-63
[PubMed:15825186] [] [DOI] (P p)

Leonard D Hudson, Catherine M Lee
Neuromuscular sequelae of critical illness.
N. Engl. J. Med.: 2003, 348(8);745-7
[PubMed:12594320] [] [DOI] (I p)

G van den Berghe, P Wouters, F Weekers, C Verwaest, F Bruyninckx, M Schetz, D Vlasselaers, P Ferdinande, P Lauwers, R Bouillon
Intensive insulin therapy in critically ill patients.
N. Engl. J. Med.: 2001, 345(19);1359-67
[PubMed:11794168] [] [DOI] (P p)

David Lacomis
Critical illness myopathy.
Curr Rheumatol Rep: 2002, 4(5);403-8
[PubMed:12217245] [] (P p)

A K Mier-Jedrzejowicz, C Brophy, M Green
Respiratory muscle function in myasthenia gravis.
Am. Rev. Respir. Dis.: 1988, 138(4);867-73
[PubMed:3202461] [] [DOI] (P p)

Laurent Papazian, Jean-Marie Forel, Arnaud Gacouin, Christine Penot-Ragon, Gilles Perrin, Anderson Loundou, Samir Jaber, Jean-Michel Arnal, Didier Perez, Jean-Marie Seghboyan, Jean-Michel Constantin, Pierre Courant, Jean-Yves Lefrant, Claude Guérin, Gwenaël Prat, Sophie Morange, Antoine Roch, ACURASYS Study Investigators
Neuromuscular blockers in early acute respiratory distress syndrome.
N. Engl. J. Med.: 2010, 363(12);1107-16
[PubMed:20843245] [] [DOI] (I p)